United Healthcare Termination: Fill & Download for Free

One large company is United Healthcare. They are Medicare and Medicaid insurers as well as private insurers. Focusing on their Medicaid lines, it is apparent to me that United Healthcare has established a pattern of arbitrary and capricious denial of nearly all claims for disabled individuals for durable medical equipment, medications necessary to provide quality of life, and payment of participating medical services providers.The metric involved is obvious: United Healthcare denies these claims knowing or believing that individuals covered by Medicaid are typically financially disadvantaged, lack access to competent representation, and that most attorneys will shy away from bringing suit against such a large corporation. The operating conceit is that an overwhelming majority of denied claims will be dropped or prescribed, and that the few claims that survive the long and arduous legal process will be a mere drop in the bucket when compared to the savings achieved by not paying out legitimate claims.I find myself in just such a situation. I am covered by United Healthcare's Louisiana Community Plan. I have been diagnosed with a number of chronic conditions which keep me from working. Chief among them is Progressive Supranuclear Palsy (PSP), a rare neurological disease which is incurable, untreatable except through symptom relief, and ultimately terminal. Another chronic condition is Failed Back Syndrome, secondary to Degenerative Disc and Joint Diseases. United Healthcare specifically use a device called prior authorizations to keep from paying claims for medications for pain relief necessary for palliative care. Claims for medical equipment are either lost or denied out of hand. United Healthcare banks (literally) on the premise that most prescribing physicians will not put up with the red tape necessary due to the miniscule compensation paid out under Medicaid guidelines. In fact, most physicians simply refuse to accept Medicaid at all.The net result is that patients like myself are denied access to necessary treatment modalities, or forced to pay for these treatments out of pocket. Having been physically unable to work for nearly a decade, paying out of pocket is simply not an option. Thus I am dying and being denied basic humanitarian care by a monolithic health insurer….The obvious solution is a class action lawsuit for violation of civil rights secured to disabled persons by the American with Disabilities Act and general equitable and constitutional principles. The insurance lobby is enormous, and I am but one insignificant and apparently disposable person. I certainly don't have the resources to prosecute this action on my own. I struggle with even the most basic expenses now days. It is a damned shame.Thank you for your question.

Hello!I can help you with that…The answer is yes. It’s a corporate trap, especially for the most vulnerable ones. The elderly…Giant insurance companies like UnitedHealthcare are advertising to the elderly in an attempt to lure them from Traditional Medicare (TM) to the so-called Medicare Advantage (MA)—a corporate plan that UnitedHealthcare promotes to turn a profit at the expense of enrollees.Almost one third of all elderly over 65 are enrolled in these numerous, complex MA policies the government pays so much for monthly. The health insurance industry wants more enrollees as they continue to press Congress for more advantages.Medical Disadvantage would be a more accurate name for the programs, as insurance companies push to corporatize all of Medicare, yet keep the name for the purposes of marketing, deception, and confusion.Elderly people enrolled in MA will experience its often merciless denials when they get sick. As hospital expert—attorney, physician, Dr. Fred Hyde put it: “It’s not just what you pay, it’s what you get.”Start with the cross-subsidy of MA from TM. In 2009, the Congressional Budget Office estimated these overpayments would cost the federal government $157 billion over the coming decade. Obama’s Affordable Care Act started to reduce these subsidies to the giant insurers, but they still amount to many billions of dollars per year.Add that with Medicare Disadvantage you are restricted to networks of vendors. That restricts your choice for competence and skills, and sometimes, requires you to travel longer distances for treatment. This could mean fewer enrollees will utilize their healthcare and more profits for the insurance companies.Under Medicare Disadvantage you are subject to all kinds of differing plans, maddening trapdoor fine print, and unclear meaning to the insurers arguing no “medical necessity” when you’re denied care.The advertisements for Medicare Disadvantage stress that you can sometimes get perks—gym memberships, hearing aids, and eyeglasses, as enticements, but they avoid telling you they are not so ready to cover serious needs like skilled nursing care for critically ill patients.Under Medicare Disadvantage, there is no Medigap coverage as there is for TM. Co-pays and deductibles can be large. Under a recent Humana Medicare Advantage Plan in Florida, your co-pay for an ambulance is up to $300, up to $100 co-pay for lab services, and another $100 for outpatient x-rays.A few years ago, UnitedHealthcare corporations dismissed thousands of physicians from their MA networks, sometimes immediately, sometimes telling their patients before telling their physicians.Dr. Arthur Vogelman, a gastroenterologist, said he received a termination letter in 2013 from UnitedHealthcare. He appealed, documenting his successful treatment of many patients. The company denied his appeal, with no reason, as it had for thousands of network physicians.Dr. Vogelman called it “an outrage. I have patients in their 80s and 90s who have been with me 20 years, and I’m having to tell them that their insurer won’t pay for them to see me anymore. The worst thing is I can’t even tell them why.” Except that the company wanted more profits.After a lengthy protest by national and state medical societies in 2013, UnitedHealthcare began to be less aggressively dismissive.Studies show the main reason MA enrollees return to TM is how badly the corporate insurers treated them when they became sick.Medicare itself is getting overly complex. But nothing like the ever changing corporate rules, offerings, and restrictions of Medicare Disadvantage. How strange it is that AARP, with its Medigap insurance business run by UnitedHealthcare, doesn’t advise its members to go with the obviously superior Traditional Medicare. AARP reportedly receives a commission of 4.95% for new enrollees on top of the premiums the elderly pay for the Medigap policy from United Healthcare. This money—about seven hundred million dollars a year—is a significant portion of AARP’s overall budget.AARP responded to my inquiries into their Medicare Advantage policy saying that it does not recommend one plan over another, leaving it to the uninformed or misinformed consumer. That’s one of AARP’s biggest cop-outs—they know the difference.There is no space here to cover all the bewildering ins and outs of what corporations have done to so-called managed Medicare and managed Medicaid. That task is for full-time reporters. The government does estimate a staggering $60 billion in billing fraud annually just on Medicare—manipulating codes, phantom billing, etc. You need the equivalent of a college-level course just to start figuring out all the supposed offerings and gaps.Suffice it to say that, in the words of Eleanor Laise, senior editor of Kiplinger’s Retirement Report, “the evidence on health care access and quality decidedly favors original Medicare over Medicare Advantage, according to a Kaiser Family Foundation review of 40 studies published between 2000 and 2014.”All this anxiety, dread, and fear, all these arbitrary denials of care—prompted by a pay-or-die commercial profit motive—all these restrictions of what doctors or hospitals you can go to, do not exist in Canada. All Canadians have a Medicare card from birth; they have free choice of health care vendors. There are few American-style horror stories there; patients have better outcomes, and almost never even see a bill. The whole universal system costs half per capita of that in the U.S., where over 80 million people are uninsured or underinsured—still! (See singlepayeraction.org, for civic action to rid Americans of this perverse chaos).Source: Wake Up AARP! A Message to Seniors: Medicare "Disadvantage" Is a Corporate Trap

Simplest answer I can give.Two of my friends, one lives in California, one lives in South Wales.They both have very similar terminal conditions.The one in South Wales is on a range of medication, regular check ups from her GP, visits to the specialists at the hospital, MRI scans etc - all free to her, which is a good thing as she can’t work.The one in California is struggling to hold down a job at a clothing retailers, so that the insurance that comes with the job will at least help cover some of the above. From what she tells me, an awful lot of the stuff my friend in South Wales gets, she will never get, as either:A: It’s not covered by the insurance.B: It’s not covered as it’s “Pre-existing.”C: She can’t afford the co-pay element.If you think that a healthcare system that refuses to treat people in need is “better” - then you are part of the problem, not part of the solution.